Why You Don't Need Antibiotics for Sinus Infections

If you've been knocked out by a sinus infection—stuffiness, face pain or pressure, and nasal discharge—it's likely your doctor will recommend you wait it out for a week or so before resorting to an antibiotic. That's because U.S. health experts recently called for doctors to think twice before prescribing antibiotics for sinus infections and other respiratory infections.

Sinus infections, or sinusitis, usually stem from a viral infection, not a bacterial one—and antibiotics don’t work against viruses. Even when bacteria does cause your sinusitis, it usually clears up on its own without drugs. In a study of 166 adults with acute sinusitis published in the Feb. 15, 2012 issue of JAMA, the journal of the American Medical Association, amoxicillin proved no better than a placebo at reducing symptoms after three days.

Not only will taking antibiotics not help you feel better, but also they come with some unpleasant side effects that might leave you feeling worse. Studies suggest that nearly 25 percent of people who take antibiotics experience side effects, such as a rash or, more commonly, diarrhea and stomach problems. The drugs also contribute to the spread of resistant superbugs, which sicken at least 2 million people in the U.S. every year. 

"For acute sinusitis, there are very well done studies indicating that antibiotics are not necessary in the vast majority of patients, and most people will be able to clear an infection on their own," says Zara Patel, M.D., assistant professor of otolaryngology at Stanford University and chair of the Education Committee for the American Rhinologic Society.

To feel better sooner, our medical consultants recommend you get plenty of rest, rinse your nose with a saltwater sinus rinse or spray, drink warm fluids, and inhale steam from a hot bath, shower, or kettle. For pain, try an over-the-counter pain reliever such as acetaminophen (Tylenol or generic) or ibuprofen (Advil or generic). 

If needed, your doctor may prescribe a prescription corticosteroid spray, such as fluticasone or triamcinolone. A systematic review published in JAMA in September 2015 found that after saline irrigation, a topical corticosteroid spray for a few days was the next best course of action for extended sinusitis.

When to Consider Antibiotics for Sinus Infections

In general, see your doctor and consider antibiotics for sinus infections only if your symptoms are very severe—meaning you develop a fever of 102 or more or have severe face pain and tenderness, if your symptoms last longer than a week or so, or if your symptoms improve and then worsen again.

"Some patients with acute sinusitis do need antibiotics, and if they continue with a worsening infection without treatment they can suffer dramatic complications such as loss of vision, meningitis, or brain abscess," says Patel. 

If your doctor says you need an antibiotic, ask for generic amoxicillin. It's usually the best choice, costs as little as $4 for a prescription, and works as well as more expensive brand-name antibiotics.
--Ginger Skinner